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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Over the past few months I have experienced some generalized

Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2419 Questions

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Posted on Sat, 16 Mar 2019 in Headache and Migraines
Question: Over the past few months I have experienced some generalized muscle twitching throughout my body, including my face occasionally. Also recently I have noticed that my left arm feels tired and weak at times. I work in a warehouse and haven’t yet been affected, but I’ve been weak and tired lately. Also have not been working out as frequently. I’m a hypochondriac and just worry about the worst whenever I notice a little thing. I know My cousin has MS and was wondering if I should be concerned about this or ALS. I had a physical back in January and my PCP told me I had nothing to worry about and it was all in my head. But he didn’t really do any tests or anything when he assured me. So I’m wondering if this is a possibility.
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Follow up: Dr. Dariush Saghafi 0 minute later
Over the past few months I have experienced some generalized muscle twitching throughout my body, including my face occasionally. Also recently I have noticed that my left arm feels tired and weak at times. I work in a warehouse and haven’t yet been affected, but I’ve been weak and tired lately. Also have not been working out as frequently. I’m a hypochondriac and just worry about the worst whenever I notice a little thing. I know My cousin has MS and was wondering if I should be concerned about this or ALS. I had a physical back in January and my PCP told me I had nothing to worry about and it was all in my head. But he didn’t really do any tests or anything when he assured me. So I’m wondering if this is a possibility.
doctor
Answered by Dr. Dariush Saghafi 3 hours later
Brief Answer:
Health Anxiety is the Modern Term for HYPOCHONDRIASIS

Detailed Answer:
Thank you for your query and I'm very sorry you're not in a better mood due to the anxious feelings you have with your various concerns having to do with health issues that concern you. You are far too young to have anything on the order of ALS. In the setting of a young person who is working hard and aware of moods of anxiousness he feels it is much more likely that twitching in the face and other parts of the body are secondary to stress and work circumstances than it is to motor neuron disease. Despite your cousin being diagnosed with MS the symptoms of weakness, tiredness, etc. is by no means a specific symptom of MS...nor any other specific diagnosis. Therefore, MS is not a reasonable first or 2nd choice in the differential diagnosis, notwithstanding your family member's having the diagnosis.

If your physician did a physical examination in January I'm sure just his review of your physical parameters (without having done any specific tests) would've revealed concerning red flags. Don't forget that doctors are trained (though he's not a specialist) to pick up on red flags even if everything thing else seems to be in order.

I'm not sure which tests you were looking for...especially since it is a well known piece of the phenomenology behind HEALTH ANXIETY (Modern Term for HYPOCHONDRIASIS) that no matter which tests or studies are performed on patients for any form of disorder, the vast majority of sufferers of the anxiety syndrome are not quite satisfied. The fact that no testing was done doesn't mean that you would've necessarily been any more satisfied if detailed and highly sophisticated were performed. This is due to the nature of the disorder. You likely know that Health Anxiety is believed to be a form of OBSESSIVE COMPULSIVE DISORDER.

This means that in a person with OCD it is almost never the case that "just 1 more test" will finally stop the worry. Doesn't that seem to be the case? If anything, performing sophisticated tests is only likely to draw scrutiny and doubt from the patient since they are always wondering if the sensitivity of the test was really as high as it could've been on THIS PARTICULAR DAY to really NOT catch anything abnormal when perhaps something really is abnormal. Doesn't that sort of summarize how you feel as far as getting medical tests and labs done?

But I can tell you that facing the root cause of what is or may be causing the anxious mood and truly CONFRONTING it along with a professional who knows how to guide the patient there and back without getting further "stuck" on nonpertinent things is quite challenging.

There are definite approaches and tactics to treating Health Anxiety and the most successful way of dealing with situations such as yours where would be the employment of a technique called COGNITIVE BEHAVIORAL THERAPY (CBT). Now, please understand that as a NEUROLOGIST my knowledge of the psychiatric/psychological aspects and management of such problems is a bit limited. However, I can tell you that if you can secure a great CBT specialist and perhaps a counselor/therapist to manage other issues you may be having such as the ORIGINS of where your health anxiety emanate that between the 2 professionals you would stand an excellent chance of licking a big portion of this problem.

If you like to read more about HEALTH ANXIETY and how it is treated by real professionals look at the clinic in White Plains, NY...which is kind of sort of close to your residence, isn't it? I mean, it's a few states UP NORTH....Ha! But, it's an option because they have a clinic with very good success numbers so you'd probably find it at the very least INTERESTING!

Oh, BTW, here's something you won't hear too many doctors tell you that you're allowed to do but I have no problem with in my patients with HEALTH ANXIETY......look things up on the Internet or in books/journals. That's right...while everybody else in the world (including YOURSELF) tells you "NOT TO LOOK ON THE INTERNET!" "PLEASE! NOT THE INTERNET!" "STOP IT! STOP IT!! STOP IT!!!" says the little inner voice you have while the little Devil on your shoulder with the Pitchfork keeps egging you on....."Go ahead...don't be scared.....it ain't gonna bite you...it's only a book...it's only a website on MS......!"

The last thing you need someone to tell you NOT to do....is the exact thing you are BURNING inside to do, right? Isn't that how XXXXXXX got in trouble with Eve and why our poor human race is in the predicament it's in???? HAHA! Just kidding....Hey, if anything came out of the Garden of XXXXXXX ...it was that, 1. It takes TWO to tango....and perhaps 2. Never listen to your better half telling to do something you know is wrong! LOL....It'll always come back to bite you...GUARANTEED!"

Look, back to your symptoms....there is definitely a workup that can be undertaken for symptoms of weakness and tiredness in the body or just plain TIRED in your MIND....right? I would never be opposed to a patient of mine getting a lab test or 2 just to rule out things that could turn out positive later which makes the doctor look kind of like...well, D-U-M-B! Ha! But that's only in the case where I know my patient hasn't yet been thoroughly examined by the doctor and cleared for anything FUNKY, etc. If so, then, heck, I wouldn't recommend repeat testing...because it almost never comes out to the patient's benefit to get ONE MORE TEST done....I'm telling you....it doesn't help.....

Since I'm not the doctor who actually examined you or took care of you I cannot draw any conclusions on your clinical condition but just based on what you've presented I can tell you that I do not think of either ALS nor MS with the symptoms you've presented.

I do hope this information has given you some perspectives on this simple BUT COMPLEX topic of HEALTH ANXIETY....notice that I referred to this query in that light. In other words, there is no plausible evidence given what you've given us the initial symptoms that you suffer from either MS or ALS....Isn't that good news? Now, you can enjoy seeing how far below zero it gets up there in Maine compared to XXXXXXX where I'm at!
LOL!.

Please consider closing this QUERY if I've provided satisfactory information to answer your questions. And if you could provide some positive feedback and a 5 star rating if you feel it is deserving well, that would just put the chocolate chip on top of the mountain of Whipped Cream for me!

This query has required 65 minutes to research, investigate, and prepare a response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
Health Anxiety is the Modern Term for HYPOCHONDRIASIS

Detailed Answer:
Thank you for your query and I'm very sorry you're not in a better mood due to the anxious feelings you have with your various concerns having to do with health issues that concern you. You are far too young to have anything on the order of ALS. In the setting of a young person who is working hard and aware of moods of anxiousness he feels it is much more likely that twitching in the face and other parts of the body are secondary to stress and work circumstances than it is to motor neuron disease. Despite your cousin being diagnosed with MS the symptoms of weakness, tiredness, etc. is by no means a specific symptom of MS...nor any other specific diagnosis. Therefore, MS is not a reasonable first or 2nd choice in the differential diagnosis, notwithstanding your family member's having the diagnosis.

If your physician did a physical examination in January I'm sure just his review of your physical parameters (without having done any specific tests) would've revealed concerning red flags. Don't forget that doctors are trained (though he's not a specialist) to pick up on red flags even if everything thing else seems to be in order.

I'm not sure which tests you were looking for...especially since it is a well known piece of the phenomenology behind HEALTH ANXIETY (Modern Term for HYPOCHONDRIASIS) that no matter which tests or studies are performed on patients for any form of disorder, the vast majority of sufferers of the anxiety syndrome are not quite satisfied. The fact that no testing was done doesn't mean that you would've necessarily been any more satisfied if detailed and highly sophisticated were performed. This is due to the nature of the disorder. You likely know that Health Anxiety is believed to be a form of OBSESSIVE COMPULSIVE DISORDER.

This means that in a person with OCD it is almost never the case that "just 1 more test" will finally stop the worry. Doesn't that seem to be the case? If anything, performing sophisticated tests is only likely to draw scrutiny and doubt from the patient since they are always wondering if the sensitivity of the test was really as high as it could've been on THIS PARTICULAR DAY to really NOT catch anything abnormal when perhaps something really is abnormal. Doesn't that sort of summarize how you feel as far as getting medical tests and labs done?

But I can tell you that facing the root cause of what is or may be causing the anxious mood and truly CONFRONTING it along with a professional who knows how to guide the patient there and back without getting further "stuck" on nonpertinent things is quite challenging.

There are definite approaches and tactics to treating Health Anxiety and the most successful way of dealing with situations such as yours where would be the employment of a technique called COGNITIVE BEHAVIORAL THERAPY (CBT). Now, please understand that as a NEUROLOGIST my knowledge of the psychiatric/psychological aspects and management of such problems is a bit limited. However, I can tell you that if you can secure a great CBT specialist and perhaps a counselor/therapist to manage other issues you may be having such as the ORIGINS of where your health anxiety emanate that between the 2 professionals you would stand an excellent chance of licking a big portion of this problem.

If you like to read more about HEALTH ANXIETY and how it is treated by real professionals look at the clinic in White Plains, NY...which is kind of sort of close to your residence, isn't it? I mean, it's a few states UP NORTH....Ha! But, it's an option because they have a clinic with very good success numbers so you'd probably find it at the very least INTERESTING!

Oh, BTW, here's something you won't hear too many doctors tell you that you're allowed to do but I have no problem with in my patients with HEALTH ANXIETY......look things up on the Internet or in books/journals. That's right...while everybody else in the world (including YOURSELF) tells you "NOT TO LOOK ON THE INTERNET!" "PLEASE! NOT THE INTERNET!" "STOP IT! STOP IT!! STOP IT!!!" says the little inner voice you have while the little Devil on your shoulder with the Pitchfork keeps egging you on....."Go ahead...don't be scared.....it ain't gonna bite you...it's only a book...it's only a website on MS......!"

The last thing you need someone to tell you NOT to do....is the exact thing you are BURNING inside to do, right? Isn't that how XXXXXXX got in trouble with Eve and why our poor human race is in the predicament it's in???? HAHA! Just kidding....Hey, if anything came out of the Garden of XXXXXXX ...it was that, 1. It takes TWO to tango....and perhaps 2. Never listen to your better half telling to do something you know is wrong! LOL....It'll always come back to bite you...GUARANTEED!"

Look, back to your symptoms....there is definitely a workup that can be undertaken for symptoms of weakness and tiredness in the body or just plain TIRED in your MIND....right? I would never be opposed to a patient of mine getting a lab test or 2 just to rule out things that could turn out positive later which makes the doctor look kind of like...well, D-U-M-B! Ha! But that's only in the case where I know my patient hasn't yet been thoroughly examined by the doctor and cleared for anything FUNKY, etc. If so, then, heck, I wouldn't recommend repeat testing...because it almost never comes out to the patient's benefit to get ONE MORE TEST done....I'm telling you....it doesn't help.....

Since I'm not the doctor who actually examined you or took care of you I cannot draw any conclusions on your clinical condition but just based on what you've presented I can tell you that I do not think of either ALS nor MS with the symptoms you've presented.

I do hope this information has given you some perspectives on this simple BUT COMPLEX topic of HEALTH ANXIETY....notice that I referred to this query in that light. In other words, there is no plausible evidence given what you've given us the initial symptoms that you suffer from either MS or ALS....Isn't that good news? Now, you can enjoy seeing how far below zero it gets up there in Maine compared to XXXXXXX where I'm at!
LOL!.

Please consider closing this QUERY if I've provided satisfactory information to answer your questions. And if you could provide some positive feedback and a 5 star rating if you feel it is deserving well, that would just put the chocolate chip on top of the mountain of Whipped Cream for me!

This query has required 65 minutes to research, investigate, and prepare a response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Dariush Saghafi 3 minutes later
I appreciate your reply. I just get concerned as it seems to be worsening, and only present in the one arm. I also believe I have lost some muscle mass in my dominant (right) leg, compared to my left leg. I didn’t know if these were related or not, but still got be thinking
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Follow up: Dr. Dariush Saghafi 0 minute later
I appreciate your reply. I just get concerned as it seems to be worsening, and only present in the one arm. I also believe I have lost some muscle mass in my dominant (right) leg, compared to my left leg. I didn’t know if these were related or not, but still got be thinking
doctor
Answered by Dr. Dariush Saghafi 30 hours later
Brief Answer:
Loss of muscle mass should always EQUAL significant LOSS OF STRENGTH

Detailed Answer:
Muscle mass that is noticeably lost from a limb will always equate into loss of strength and if the 2 legs (in this case) have differing losses of mass then, significant strength differences should be seen upon testing.

Also, loss of muscle mass should also always equate to LOSS OF WEIGHT.

Do you have significant losses in muscle STRENGTH and LOSS of weight. If your doctor has examined you and not found any of the vital statistics to be different on exam then, my guess is that you've likely not lost any mass as you believe. Of course, measurements of the limbs is another very easy and REPRODUCIBLE parameter for which no dispute can be made as to its existence. Measurements of the limbs should be done by a doctor familiar with how to do this properly. It's got its technique to be sure.

Twitching can be seen in one limb and not others and this is not taken to be abnormal. Twitching is also virtually never a FIRST sign of problem in a person with true motor neuron disease such as ALS.

Again, my best recommendation to follow up on these concerns is to alert your doctor to your specific concerns of muscle mass loss as well as isolated twitchings and to see what his response may be...but also not to take things too far given your recognition of the problem of Health Anxiety that you have....if your weight or neurological strength were significantly changing, your doctor would recognize something were afoot and would most likely have sent you to a neurologist for further evaluation.

I shall be very grateful if you'd do me the favor of closing this QUERY and rating my responses to your questions. My hope is that you will find the answers highly satisfactory and provide some positive feedback as well as a 5 star rating if you feel so moved.

Tally Ho!

This query has required 80 minutes to research, investigate, and prepare a response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
Loss of muscle mass should always EQUAL significant LOSS OF STRENGTH

Detailed Answer:
Muscle mass that is noticeably lost from a limb will always equate into loss of strength and if the 2 legs (in this case) have differing losses of mass then, significant strength differences should be seen upon testing.

Also, loss of muscle mass should also always equate to LOSS OF WEIGHT.

Do you have significant losses in muscle STRENGTH and LOSS of weight. If your doctor has examined you and not found any of the vital statistics to be different on exam then, my guess is that you've likely not lost any mass as you believe. Of course, measurements of the limbs is another very easy and REPRODUCIBLE parameter for which no dispute can be made as to its existence. Measurements of the limbs should be done by a doctor familiar with how to do this properly. It's got its technique to be sure.

Twitching can be seen in one limb and not others and this is not taken to be abnormal. Twitching is also virtually never a FIRST sign of problem in a person with true motor neuron disease such as ALS.

Again, my best recommendation to follow up on these concerns is to alert your doctor to your specific concerns of muscle mass loss as well as isolated twitchings and to see what his response may be...but also not to take things too far given your recognition of the problem of Health Anxiety that you have....if your weight or neurological strength were significantly changing, your doctor would recognize something were afoot and would most likely have sent you to a neurologist for further evaluation.

I shall be very grateful if you'd do me the favor of closing this QUERY and rating my responses to your questions. My hope is that you will find the answers highly satisfactory and provide some positive feedback as well as a 5 star rating if you feel so moved.

Tally Ho!

This query has required 80 minutes to research, investigate, and prepare a response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Dariush Saghafi 9 hours later
Would the weakness be very noticeable or would it be subtle at first? Because I have slight weakness in one arm but my hand is still working fine
default
Follow up: Dr. Dariush Saghafi 0 minute later
Would the weakness be very noticeable or would it be subtle at first? Because I have slight weakness in one arm but my hand is still working fine
doctor
Answered by Dr. Dariush Saghafi 4 hours later
Brief Answer:
Weakness should be evaluated by a doctor not by oneself

Detailed Answer:
Good morning and thank you for the return question.

I would recommend that you not be the one to actually carry out the measurement or assessment of your muscle strength to compare to one side with the other since you cannot really be an accurate or unbiased judge. Many factors play into "subtle" weakness" and the concept of there being a motor neuron disease such as ALS adds another layer of complexity to the evaluation process since muscles have great reserve capacity...especially in young people.

The bottom line is this....your age really makes the likelihood of ALS, extremely unlikely...unless it is diagnosed in a 1st degree relative and even then, it is doubtful that you would exhibit symptoms any sooner than when your relative first came to medical attention.

If your muscle mass loss is noticeable enough to be measurable by a doctor then, the expectation is that significant evidence of weakness would be present, falls, trips, stumbles (other than missteps on a sidewalk, etc.). If the muscle mass loss you've mentioned is in a limb where NO twitching or fasciculations are seen then, this would be a bit strike against motor neuron disease being present since twitching should always PRECEDE and be obvious in a limb which has lost mass and strength.

The fact that hand function is normal is very positively against a diagnosis of motor neuron disease as well in this setting.

Therefore, I believe that despite your doctor's not having performed "tests"...that his intuition has correctly guided him to the conclusion that you do not suffer from this illness.

It would, however, be very much to your advantage to discover how to approach the issue of Health Anxiety and if you would like some information regarding that part of the equation which has likely made things difficult for you not only with thinking about motor neuron disease but other things as well please let me know. You are definitely not alone and I also don't agree with any perspective that says that "it's all in your head" since where else would any of us keep our thoughts, our feelings, our sentiments, etc.? Thank GOODNESS that there is nothing OUTSIDE your head....LOL.....

You get the idea, right? I have many patients who suffer from health anxiety, it's a tough nut to crack some times, it often times involves highly intelligent, functional people who are well educated, are hard working in good stable positions, have families, and are otherwise productive in society....the problem is they suffer from what many feel is a significant subset of OBSESSIVE/COMPULSIVENESS which has translated into health issues which they believe they have but cannot get sufficient confirmation that they do not...creating a vicious circle that may temporarily cease with one problem only to be replaced in short order by something else which could be triggered by an event in their lives, or even a real health problem they overcome but feel has potentially set them on a path that opens the door to other more sinister things that are or may be coming.

Once again, I am very interested in helping you confront some of these concerns you've raised and would encourage your confidence in your doctor's assessment of your health which he feels is on the right track though improving things on the the health anxiety front is clearly in your best interest. Heck....you live the State of Maine....you guys up in the New England area of the country have the highest life expectancies of anybody in the country! LOL....I believe Maine ranks 25th in the US and its territories....while my poor State of Ohio is 39th! Please, can I have a little of the air you're breathing up there? BUT NOT THE COLD.....BUT YES, to the LOBSTER....lots of Omega 3 FA's! HAHA!

Cheers!

I'd very much appreciate your attention to CLOSING THIS QUERY if I've satisfactorily answered your questions with a 5 STAR rating and some positive feedback if you feel it merits such action. Please feel free to contact me in the future at: www.bit.ly/drdariushsaghafi for more questions on this or any other topic.....and congrats to your Pats BTW for pulling yet another phenomenal season and Super Bowl win. Did you know that XXXXXXX Belichik was head coach for the Browns but could never really turn the ship around? Goes to New England...BAM.....how the heck does that happen? It's that New England Air!

This query has required 114 minutes to research, investigate, and prepare a response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
Weakness should be evaluated by a doctor not by oneself

Detailed Answer:
Good morning and thank you for the return question.

I would recommend that you not be the one to actually carry out the measurement or assessment of your muscle strength to compare to one side with the other since you cannot really be an accurate or unbiased judge. Many factors play into "subtle" weakness" and the concept of there being a motor neuron disease such as ALS adds another layer of complexity to the evaluation process since muscles have great reserve capacity...especially in young people.

The bottom line is this....your age really makes the likelihood of ALS, extremely unlikely...unless it is diagnosed in a 1st degree relative and even then, it is doubtful that you would exhibit symptoms any sooner than when your relative first came to medical attention.

If your muscle mass loss is noticeable enough to be measurable by a doctor then, the expectation is that significant evidence of weakness would be present, falls, trips, stumbles (other than missteps on a sidewalk, etc.). If the muscle mass loss you've mentioned is in a limb where NO twitching or fasciculations are seen then, this would be a bit strike against motor neuron disease being present since twitching should always PRECEDE and be obvious in a limb which has lost mass and strength.

The fact that hand function is normal is very positively against a diagnosis of motor neuron disease as well in this setting.

Therefore, I believe that despite your doctor's not having performed "tests"...that his intuition has correctly guided him to the conclusion that you do not suffer from this illness.

It would, however, be very much to your advantage to discover how to approach the issue of Health Anxiety and if you would like some information regarding that part of the equation which has likely made things difficult for you not only with thinking about motor neuron disease but other things as well please let me know. You are definitely not alone and I also don't agree with any perspective that says that "it's all in your head" since where else would any of us keep our thoughts, our feelings, our sentiments, etc.? Thank GOODNESS that there is nothing OUTSIDE your head....LOL.....

You get the idea, right? I have many patients who suffer from health anxiety, it's a tough nut to crack some times, it often times involves highly intelligent, functional people who are well educated, are hard working in good stable positions, have families, and are otherwise productive in society....the problem is they suffer from what many feel is a significant subset of OBSESSIVE/COMPULSIVENESS which has translated into health issues which they believe they have but cannot get sufficient confirmation that they do not...creating a vicious circle that may temporarily cease with one problem only to be replaced in short order by something else which could be triggered by an event in their lives, or even a real health problem they overcome but feel has potentially set them on a path that opens the door to other more sinister things that are or may be coming.

Once again, I am very interested in helping you confront some of these concerns you've raised and would encourage your confidence in your doctor's assessment of your health which he feels is on the right track though improving things on the the health anxiety front is clearly in your best interest. Heck....you live the State of Maine....you guys up in the New England area of the country have the highest life expectancies of anybody in the country! LOL....I believe Maine ranks 25th in the US and its territories....while my poor State of Ohio is 39th! Please, can I have a little of the air you're breathing up there? BUT NOT THE COLD.....BUT YES, to the LOBSTER....lots of Omega 3 FA's! HAHA!

Cheers!

I'd very much appreciate your attention to CLOSING THIS QUERY if I've satisfactorily answered your questions with a 5 STAR rating and some positive feedback if you feel it merits such action. Please feel free to contact me in the future at: www.bit.ly/drdariushsaghafi for more questions on this or any other topic.....and congrats to your Pats BTW for pulling yet another phenomenal season and Super Bowl win. Did you know that XXXXXXX Belichik was head coach for the Browns but could never really turn the ship around? Goes to New England...BAM.....how the heck does that happen? It's that New England Air!

This query has required 114 minutes to research, investigate, and prepare a response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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